Fertility issues are not widely discussed – in society or the workplace – and relatively few organisations have policies or guidance in place to support people having treatment. Just over a quarter (27%) of the 2,023 employers we surveyed have either a standalone policy or include provision as part of a wider policy. The CIPD wants to help bridge this gap by encouraging organisations to view fertility as an important workplace wellbeing issue and by providing practical guidance about the support employers can put in place.
It can be a long and uncertain road for employees experiencing difficulties conceiving, trying to have or grow a family. It is often emotionally draining, socially challenging and financially tough. There can be significant impacts on mental and physical health. Managing these impacts alongside employment can be extremely difficult without an understanding employer. Given that the majority of people wanting to start or grow a family are of working age, it’s safe to assume that it’s typically people who are in employment who are affected.
Building on our research findings, this guide will help people professionals develop effective support for employees experiencing fertility challenges, investigations or treatment. It aims to provide knowledge and practical guidance to help employers and people professionals develop ‘fertility friendly’ organisations.
Purpose, aims and principles of this guide
This guide aims to:
- raise awareness of the prevalence and impact of fertility challenges, investigations and treatment
- highlight the need for effective workplace support and what that might look like
- inspire employers to create an environment where individuals feel able to access support if they want to.
Overall, our survey findings suggest a positive impact of effective employer support in areas such as mental wellbeing, commitment and intention to stay with your employer. The way an employer responds can have an impact on how an employee copes and whether or not they remain in work, as well as on their longer-term view of their employer. It also sends a message to the rest of the workforce about whether the organisation genuinely cares for the health and wellbeing of its people. In addition, the provision employers develop here will form part of an attractive employer value proposition to recruit and retain talented people.
We believe any support provided should be underpinned by the principles of compassion, empathy and inclusivity.
The CIPD’s aim in producing this guidance is to encourage organisations to be as inclusive as possible in how they support people experiencing fertility challenges, investigations or treatment. By ‘fertility challenges, investigations or treatment’, we mean any employee experiencing difficulties conceiving, or undergoing any investigations or type of treatment for fertility, or supporting a partner who is undergoing investigations or treatment. This includes men and women, same-sex couples, people pursuing parenthood alone, people choosing to delay parenthood (ie through egg freezing) and people with secondary infertility (ie who have a child or children but are having difficulties conceiving again). It’s also important to recognise that some people could use surrogacy to start or grow a family and they too could experience infertility.
Men and women can experience fertility problems. While it is often necessary for the woman to undergo the medical aspects of treatment, both partners can equally experience the emotional and mental health impacts of undergoing fertility challenges, investigations and treatment, and so policies should be inclusive of partners. It’s important to ensure the language used in policies and practices is inclusive and also to not assume someone’s personal situation or family make-up.
We know employers come in all shapes and sizes, with different working practices and environments. This guide is designed to support any employer wanting to develop a supportive framework. The practical suggestions can be adapted for different work environments.
Drawing on our survey findings and wider research, the guidance is structured around five principles of good practice to help you design the support that would be most helpful to your employees:
- Raise awareness across the organisation about the need for fertility challenges, investigations or treatment to be recognised as an important workplace wellbeing issue that can affect both mental and physical health. Education and awareness-raising require careful thought and sensitivity in terms of language and approach, and so it’s a good idea to involve employee networks or resource groups, and draw on reliable sources of expert advice.
- Create an open, inclusive and supportive culture. The aim is to break down the stigma and ensure that people know they will be supported if they want to tell people about their experience. Communicate positive messages about the support available and set the expectation that line managers and colleagues show empathy and understanding.
- Develop an organisational framework to support employees experiencing fertility challenges, investigations or treatment. This should include specific policy provision, manager guidance and education as well as access to sources of expert help, such as an employee assistance programme and signposting to external specialist charities.
- Manage absence and leave with compassion, clarity and flexibility. Given the lack of statutory provision to support employees with fertility investigations and treatment, consider how generous the organisation’s policy can be in offering paid leave and flexibility, and clearly state what people are entitled to. Absence management policies and procedures should be flexible and take into account the potential impacts of experiencing fertility challenges, investigations or treatment, for both partners.
- Equip line managers to support people with empathy and understanding. Managers play a central role in supporting people’s wellbeing and implementing people management policies. Employers cannot expect managers to act as counsellors or medical experts. Their role is to help employees with the work aspects of the situation and ensure that work is not part of the problem. Therefore, organisations should ensure that managers understand the boundaries of their role, and when and how to signpost to specialist support. They need to build trust-based relationships so that someone will feel able to talk about their need for support or workplace adjustments, while also maintaining their privacy at work.
Please note that we are not providing legal or medical advice, but practical ideas of workplace support that may benefit employees. Employers may also need to obtain their own specialist advice on the approach to take in any individual case.
Why are fertility challenges, investigations and treatment a workplace issue?
“It is possibly the hardest thing I’ve been through and trying to do it with very limited support from your employer is impossible. It’s had long-term effects on me both mentally and financially.” Respondent to CIPD employee survey
Because fertility challenges, investigations and treatment are typically ‘hidden’ issues, the importance and benefits of a supportive work environment haven’t been widely discussed. Some employers may think fertility challenges are personal and have nothing to do with the workplace. Some employees may also feel this way and choose not to share their experience, which should be respected. However, having a framework of support in place gives people the choice to access support if they want to.
Understanding fertility challenges, investigations and treatment
According to the NHS, infertility is when a couple cannot get pregnant (conceive) despite having regular unprotected sex. There are two types of infertility:
- primary infertility – where someone who’s never conceived a child has difficulty conceiving
- secondary infertility – where someone has had one or more pregnancies in the past, but is having difficulty conceiving again.
Infertility affects around one in seven couples – approximately 3.5 million people in the UK – most of whom are in employment. There are many different treatments for fertility problems, including but not limited to:
- medical treatment for lack of regular ovulation
- surgical procedures such as treatment for endometriosis, repair of the fallopian tubes, or removal of scarring (adhesions) within the womb or abdominal cavity
- assisted conception such as IUI or IVF
- using a donor and/or treatment through surrogacy.
Treatments may involve frequent medical appointments. Length of treatment, number of treatments and side effects all vary considerably, which mean fertility journeys are highly individual, unpredictable and complex.
There are various reasons why fertility challenges tend to be a hidden issue. As well as the societal taboo around discussing infertility, there’s a persistent high level of pregnancy and maternity discrimination at work, which influences how comfortable people feel sharing their experience. People may be reluctant to tell their manager or colleagues that they are trying for a baby for fear of being overlooked for career opportunities or being seen as not committed at work.
Fertility challenges, investigations and treatment need to be recognised as an important workplace wellbeing issue. Experiencing difficulties conceiving can be extremely stressful, as people can be going through an uncertain journey of investigations and treatment, which can take up considerable time and energy. Most people find it very challenging to balance these demands alongside paid employment. The challenges people encounter are often exacerbated by a lack of understanding and openness regarding fertility issues, which can prevent employees seeking the support they need. Our survey of 300 people who had experienced fertility challenges, investigations or treatment in the UK found that almost half (47%) had not informed their manager or HR.
Research by Manchester Metropolitan University highlights the logistical, physical, emotional, social and financial challenges that employees who experience fertility challenges, investigations or treatment may face. These include:
- attending multiple (sometimes daily) clinic appointments – often arranged with little notice
- finding the time and privacy to take sensitive phone calls from the clinic during the working day, coupled with the anxiety of waiting for, and potentially missing, important updates
- storing medication (which may require refrigeration) at work and finding a clean and private place to inject medication
- ‘cycles of hope and grief’, the challenge of receiving difficult news at work and managing the significant emotional transition if treatment is unsuccessful
- potential strain on relationships both inside and outside work.
In addition, costly private treatment may place pressure on employees to work additional hours, attend work when sick, gain a promotion or secure permanent work. Others may suffer financially due to the incompatibility of their treatment with their work. For example, individuals sometimes leave their jobs, step down, reduce their hours, take career breaks, or avoid applying for promotion.
Our UK employee survey found that of the people who said they hadn’t told their employer about their experience of fertility challenges, investigations or treatment, 26% said this was because they were concerned about the possible impact on their career. As well as preventing any discrimination due to personal and family circumstances, it’s in employers’ interests to create inclusive and supportive working cultures that attract and retain valuable talent.
For employers, there is a clear rationale for action. Making employer support available sends an important message that the organisation values employees and their health and wellbeing, and recognises the difficulties they are going through.
Just like any other wellbeing issue, effective support can help people stay in work and perform well in their job. In our employee survey, on the whole, respondents who felt very or quite supported by their organisation/line manager/colleagues report a positive impact on each of the outcomes from the support they received. The strongest impact from all three sources of support was on people’s mental wellbeing. In contrast, around one in five (19%) employees considered leaving their job because of their experience at work.
Offering compassionate support can have a significant impact, helping someone to balance work demands with their personal situation. If employees feel supported and can access helpful adjustments at work, resources and/or flexibility, they are more likely to feel able to work to the best of their ability.
Conversely, where there is an absence of effective support, organisations as well as individuals can experience adverse outcomes. In addition to the loss of talent, skills and experience, employees exiting the workforce can add to HR professionals’ workload and organisational cost in terms of recruitment and training. Furthermore, the long-term absence or exit of a team member can have a significant knock-on effect for other team members, affecting their workload, motivation, engagement and wellbeing.
“I left my job to focus on IVF as my role was too demanding.”
“I decided to leave my job/not return to that employer after we were successful with IVF because of how difficult the IVF journey was and because the stress from work had a negative impact at times. I didn’t want that again.”
Respondents to CIPD employee survey
Developing an effective framework of support can help ensure employees who have experienced fertility challenges, investigations or treatment are managed fairly. It demonstrates that the organisation cares about its people as well as helping it to retain valuable skills and talent.
Create an open, inclusive and supportive culture
Promoting wellbeing and inclusion in the workplace is an important aspect of good people management – it’s about valuing and supporting everyone as an individual. Those experiencing fertility challenges, investigations or treatment should feel supported and included in their working environments. We need to normalise the conversation about fertility issues in the workplace, so that people can access support when they need it. This kind of culture can have far-reaching benefits in supporting employees through many different and challenging life events.
“I felt very embarrassed and worried that it would make people think less of me.”
“I think it makes people uncomfortable so they avoid talking about it!”
Respondents to CIPD employee survey
There are still taboos about fertility issues. The resulting silence and stigma inevitably spills over into the workplace. For example, our research shows that only around a quarter (24%) of UK senior decision-makers reported that their organisation encourages an open and supportive climate where employees can talk about issues like pregnancy loss or fertility treatment to a great extent.
Employers can play an important role in breaking down these taboos. Employees working in supportive and compassionate environments are more likely to feel able to discuss a wellbeing issue or a challenging life event, to ask for help when needed, and to make an effective return to work. When managers manage well and build trust-based relationships with their team, they help to create an environment that is open, respectful and kind, in which people feel ‘psychologically safe’. This means individuals feel able to speak up about a health or personal issue without fear of criticism or discrimination, and in the knowledge they will be listened to and receive support and understanding.
Organisations should aim to build a culture of psychological safety, where good working conditions and supportive conversations are prioritised, and mental health and physical health are given equal standing. Too often, fertility challenges are not part of the narrative in organisations, and ensuring that it is explicit in policies, training and guidance will help to guide people how to behave as well as letting people know the support that is available.
One of the steps in the voluntary Fertility Workplace Pledge in the UK involves organisations establishing the role of a fertility ambassador who can be a source of knowledge and signposting about fertility issues, and engage with employees to raise awareness and build a supportive climate.
Employers should communicate a compassionate and inclusive attitude towards fertility issues, so that all employees know that their employer is supportive. Developing a policy and/or guidance which recognises fertility challenges, investigations or treatment as a health and wellbeing issue is a good starting point, but organisations should also consider how they communicate that policy and the support available. Think carefully about tone to ensure that it’s compassionate and supportive, and the language is appropriate and inclusive. It’s also important to be proactive in this communication, for example through holding employee events on the topic and promoting the support available, so that there is an obvious awareness and acknowledgement of the issues around fertility support.
Developing awareness and understanding among managers and colleagues about fertility issues can help to build a compassionate and supportive culture. A caring attitude can help reduce the stress and isolation of a difficult fertility journey, and yet many people worry about saying the wrong thing.
Information and education should be included as part of any relevant training and there should be clear signposting to internal and external sources of support. Encouraging peer-to-peer discussions (for example, through employee networks and/or buddies) can also help encourage more openness and understanding around fertility challenges, reduce feelings of isolation and provide valuable support.
Some employees might not want to approach their line manager, so other options should be available. This may be through HR, an employee resource group or a welfare officer. Many employers have employee assistance programmes (EAP) that can be a confidential source of help and advice. Other routes of support can also help if a manager feels unable to support their team members on this issue, and there should be support in place for the manager themselves.
It’s vital that organisations integrate their support for people experiencing fertility challenges, investigations or treatment within their framework for creating a mentally healthy workplace. Creating an open culture of support will help ensure that people in this situation will feel more comfortable raising any issues and asking their manager for support. The organisation’s culture should foster openness and inclusion around mental health issues where people feel able to talk about how they are feeling and seek support if they need it. Individuals can experience mental health issues connected to fertility issues at any stage – for example, if treatment is unsuccessful, but also if it is successful, in the form of perinatal mental illness.
The CIPD/Mind people managers’ guide to mental health provides practical advice on how to develop a mentally healthy workplace.
Partners often provide practical and emotional support to their partner, and also feel the impact of the fertility challenges themselves. The workplace can play an important role in giving partners time and space to look after their wellbeing, as well as potentially signposting to specific support they may not otherwise find. For example, men may be less likely to proactively seek support for issues like mental health. It’s important to consider the perspective and needs of partners in your promotion of available support, as otherwise employees might see the policy as only relevant to employees undergoing investigations or treatment.
It’s also important to communicate in an inclusive way so everyone feels able to access support, for example same-sex couples. You should also recognise that individuals of any gender can be undergoing treatment. Some employees could be going through fertility challenges, investigations or treatment as a single person, without the support and shared experience of a partner.
The workplace can mirror society in terms of perceptions and unconscious bias around what a family is. There can be an assumption about children being a necessary part of people’s lives, for example, which can be challenging to deal with if someone is experiencing fertility issues. An inclusive culture means countering stereotypes about who may experience fertility issues (for example, it could be men as well as women, same-sex couples, single people and surrogates) and is also inclusive of different family structures.
Organisations should also be sensitive to any cultural or other diversity considerations. For example, individuals from certain cultures or backgrounds could feel less comfortable talking about fertility challenges, investigations and treatment. It could also be the case that someone who talks about their experience may not have previously shared a same-sex relationship, or may be pursuing parenthood as a single person.
Trust is critical. People will only feel comfortable to ask for help, or access support available, if they trust their employer and manager to treat them fairly. Organisations need to provide genuine reassurance that work and career opportunities will not be jeopardised.
People’s experience of fertility issues, challenges or treatment varies considerably. It’s important not to make assumptions and to take the lead from the individual in terms of what they would like to share and what support they might need. For example, don’t assume that people on fertility journeys or living with involuntary childlessness don’t want to join in or hear about family events. For some people who are experiencing challenges conceiving, or unable to have children, being involved in others’ families can be rewarding. However, other people may find baby celebrations at work difficult and prefer not to attend. Every situation is unique to that individual. The key is to understand what each employee wants in terms of support and compassion, which is why a sensitive conversation is key to understanding their needs and concerns.
No one should feel pressured to discuss their situation if they don’t want to. However, they should still be able to access support. The onus should be on the organisation to create an open and supportive culture where people can talk and seek support if they want to.
There needs to be awareness and sensitivity around certain events that could be upsetting, such as Mother’s Day or Father’s Day, pregnancy announcements and baby showers. Organisations should ensure that managers actively support employees who may be living through very contrasting personal situations. This doesn’t mean that employees expecting a child can’t share their experience and anticipation, but managers and colleagues need to show compassion and sensitivity if they know another colleague has not been so fortunate. For example, supportive managers might have conversations about how best to support someone, including having an agreement around pre-warning, allowing the individual to excuse themselves or be busy elsewhere at points that could be particularly triggering.
In general, people benefit from sympathetic concern and support from colleagues and managers. However, it can be hard to know what to say to a colleague who has shared their experience. Some people worry about saying the wrong thing and so say nothing at all, which could feel very isolating for someone who is having a difficult time. It’s important to be guided by the individual experiencing the situation, and some people may choose not to discuss it. This should be respected, but colleagues can still ask how someone is, showing they care but giving the individual the choice and space in how to respond.
Fertility Network UK says that even the most well-meaning comments can be unintentionally hurtful or cause misunderstandings. Therefore, organisations should provide simple guidelines to help managers and employees to have supportive and appropriate conversations. Key advice, drawn from people experiencing fertility problems, includes:
- Asking questions: in general, people prefer it if people show an interest in their problems and ask how their investigations/treatment are going and how they are feeling – it is better to ask (or ask if it is okay to ask) than to say nothing because you are afraid of upsetting them, as this can give the impression that you don’t care.
- Acceptance and advice: it’s very important to accept that the person really does have a fertility problem if they tell you so. It’s best to leave advice to the medics.
- Reassurance and encouragement: there is little reassurance you can give to a couple about whether they will eventually have a baby. Going for fertility treatment is not like going for a job interview; a positive attitude does not improve the chance of success, so advocating ‘positive thinking’ is not necessarily helpful.
- Empathy and support: infertility can be experienced like a bereavement. The grieving process is long and drawn out because they may find it hard to start to come to terms with their loss until they are satisfied they have tried all the options they are prepared to undergo, or can afford.
Implementing a policy and/or framework is not a one-off event. It’s important to continue promoting the organisation’s policy and support framework and reinforce compassionate messaging around the topic. Otherwise, it can slip off the agenda and employees won’t know where to turn for support when they need it. Talking about the value of a supportive workplace and signposting to specialist professional sources of support will also raise awareness.
Opportunities for awareness-raising include health and wellbeing days and national awareness days, including the UK’s annual National Fertility Awareness Week, a Fertility Network UK initiative. There is also a World Childless Week in September “for anyone who is childless despite their longing to be a parent because they have never been pregnant (for any reason), not carried full term or have suffered the sadness of a baby born sleeping”.
In addition, information, education and the workplace support available relating to fertility issues can be promoted at specific events, included in equality, diversity and inclusion (EDI) and wellbeing training for the whole workforce, and awareness of the policy and support available integrated into induction programmes for new starters. Online resources, video stories, networks and forums can help ensure information and support is readily available when needed for both people experiencing fertility challenges themselves and those who want to support them. External organisations and charities also provide a range of useful advice and guidance.
“I’ve been fortunate to have two different employers be very understanding and flexible during different cycles … I’m glad I didn’t put my life on hold for treatment as it took a while and work could be a welcome distraction, but it certainly wouldn’t be the same for everyone… I told my manager and only one colleague… I didn’t want sympathetic looks or people asking how I was when it was at its most uncertain; it helped me to keep work more business as usual. My clinic was close to the office, which helped, so check-ups were only short breaks, but picking up meds took a trip across town and a long queue at the hospital pharmacy, so flexibility on time out was most valuable.”
Respondent to CIPD employee survey
Develop a framework to support employees
Developing a framework to support employees with fertility challenges, investigations and treatment demonstrates a commitment to employee wellbeing and EDI. It can also encourage more people to talk about it if they want to, seek support and remain productive at work. People professionals are ideally placed to develop a proactive framework to support people. They have the strategic oversight to understand which policies are relevant or need to be developed, the current organisation culture and the work needed to develop it, as well as the ability to ensure that effective support is in place.
People professionals should also be in a position to:
- develop a policy that outlines the support available, written in a compassionate and supportive way
- ensure that senior management recognise fertility challenges, investigations or treatment as a legitimate workplace wellbeing issue
- integrate appropriate education and training provision into line manager development interventions – a policy is not complete without a plan to embed it and ensuring managers feel capable and confident to implement it.
The framework that employers develop will have a direct influence on how compassionate and supportive the climate is and how capable and confident managers feel to support people. We now explore some of the key factors to consider in developing an inclusive framework.
Creating a framework to support employees experiencing fertility challenges, investigations or treatment means recognising this is a health and wellbeing, EDI and people management issue. The organisation needs to develop a holistic approach, and align relevant provision across policies and practices in all of these areas to be effective.
The first step is to audit the existing provision to evaluate what support is already available, and where there are gaps. For example, do you have an EAP or access to counselling services? Does your people management approach and training stress the importance of what are often termed the ‘softer’ management skills, including compassion, inclusiveness and empathy?
Developing a dedicated, transparent and readily accessible policy or plan will:
- offer an opportunity to engage with employees on the issue and show that the organisation regards fertility challenges, investigations or treatment as an important issue
- provide clarity, for example by setting out key responsibilities, entitlements and sources of support
- prompt HR to systematically audit existing provision and think strategically and practically about how to develop the most effective framework
- enable HR to collaborate with its occupational health (OH) service, if it has one, and any EAP partners, to develop an organisational framework that’s informed with specialist input and fully integrated into OH policies and practices
- encourage consistency in how the organisation and individual managers support employees and offer time off and access to adjustments
- establish the framework for evaluating the impact of the organisation’s provision.
A policy covering fertility challenges, investigations and treatment should be consistent with the organisation’s wider people management policy provision, and cover key areas.
Statement of principles
- How the organisation is committed to supporting employees experiencing fertility challenges, investigations or treatment.
- How its intention is to be inclusive in recognising that partners can also be significantly affected, and that support is available to anyone experiencing these issues.
- Language inclusive of all family make-ups, identities and circumstances, for example same-sex couples and employees pursuing parenthood as a single person.
- The actions that the organisation will take to implement the policy.
- The key outcomes it wants to see, such as a more open and inclusive culture so that people feel able to discuss fertility issues and seek the support they need.
- Of the fertility issues covered under the policy and its scope to provide clarity among all employees (such as investigations, treatments, number of treatments, surrogacy, adoption, etc).
- Setting out which employee groups have responsibility for implementing specific aspects of the policy, including senior managers, line managers, HR, employees and OH.
How absences will be managed and recorded
This is discussed further in the section on Managing absence.
Pay and time off
- Detail on the provision available for people (including partners), such as number of days’ paid leave for appointments.
Links to internal and external sources of support
- OH, EAP, counselling services, any internal employee networks and external support groups and specialist charities.
- Relevant policies such as flexible working.
Activities and initiatives
- Education and awareness-raising across the whole workforce.
- Line manager training.
Research by Cawthorne and Hardy (2023) investigated what key policy items should be included in public sector workplace policies regarding assisted reproductive technologies and treatments, such as IVF. These policy items may form part of separate policies and can be linked to from the fertility policy. The resulting policy checklist, presented in order of importance, is as follows:
Included in policy (yes or no)
Is this information included in the workplace policy for assisted reproduction?
What information is included/excluded and what reason is given?
Guidance on recording absences from work
Options for managers supporting staff at work
Awareness of fertility benefits if applicable (such as time off for appointments, etc)
Signposting to internal resources (such as mental health support like the EAP or mental first aid or OH, etc)
Signposting to external resources (such as charities and support groups, etc)
Signposting to relevant policies (such as adoption/fostering, maternity, pregnancy loss/miscarriage and LGBT+)
Information on the impact of fertility treatment at work (such as the psychological and physical impact, common side effects of medications, frequency of appointments, etc)
Basic information regarding fertility and treatment (such as how common it is, different types of treatment and the unpredictable nature of treatment, etc)
Information for employees going through surrogacy
May form part of a separate policy
Legal implications (such as the legal protected period following embryo transfer, or risk of sex discrimination, etc)
Information on pregnancy loss/miscarriage
May form part of a separate policy
Source: Cawthorne, R. and Hardy, C. (2023) Assisted reproduction policies in the workplace: A modified Delphi study (under review).
The study recognises that employers range in their ability and willingness to provide policies, training and support for employees seeking assisted reproduction. Therefore, they should use the checklist as a starting point for policy development, considering the inclusion of each policy item in turn, and recognising the need to tailor information to the context of their workplace. The policy items are neither mandatory nor exhaustive, and factors such as organisation size and resources will have an impact on many of the policy items.
The full checklist is available to download below.
The CIPD’s own fertility journey policy for employees is included below.
Not every organisation will decide that having a standalone policy is appropriate for its culture or people management framework. It may prefer to incorporate provision within or across its existing policies, where relevant, and develop dedicated line manager guidance and training to bring this policy provision to life. The positioning of the policy and its framing needs careful consideration to ensure that it is perceived as supportive and compassionate.
Our research shows just 7% of employers have a standalone policy in place concerning fertility treatment, with a further one in five (20%) covering it as part of a wider policy. A third (35%) of employers who cover fertility treatment within a wider policy include it in their wider health and wellbeing policy, 6% include it in a women’s health policy and 2% in a reproductive health policy. But the main approach (44% of employers) is to include provision in their policy on maternity/paternity/shared parental leave. However, it’s not recommended that fertility policies are located under maternity/paternity or parental leave policies, which are there to support those already pregnant, as this can feel insensitive.
Further, those employers who reference fertility treatment in their women’s health policy should be mindful that men can also experience fertility challenges, investigations or treatment. To be inclusive it should be referenced in a men’s health policy if there is one. If not, it’s best to position the topic as a standalone policy or within a wider health and wellbeing or reproductive health policy.
It’s important to listen to employees themselves about how the most effective provision can be developed and what it should look like. Tap into any employee networks and/or volunteers, such as those championing health and wellbeing or EDI issues. Some employee volunteers or networks may have lived experience of fertility challenges, and their feedback, if they are comfortable to provide it, will be invaluable to inform areas such as:
- the kind of policy provision and support that will be most helpful
- helpful external sources of support and networks
- appropriate language and tone
- how best to build awareness of the topic and the support available.
If the organisation involves employees with lived experience, this should be approached with the utmost sensitivity, and appropriate wellbeing support should be made. People should not feel under any pressure to contribute at any stage. Remember, however, that these groups may only represent a small part of a larger community affected by fertility challenges, investigations or treatment. First, not all employees affected will necessarily join an employee network, and so it won’t capture all employees’ experiences and views. Second, partners may not be equally represented on employee networks or resource groups.
Everyone will experience their fertility journey differently, have different needs and therefore find different forms of support useful. It’s essential to treat everyone as an individual and not assume what they may need. Instead, be guided by them through a sensitive and supportive conversation. Although the support someone requires will be individual to them, our research findings suggest that paid leave and manager support are two particular areas that employers may want to consider investing in.
In any conversation, HR professionals and/or managers should be proactive and tell the employee what support and policies are available, for example the type of leave they could take. This means people don’t need to ask for support at the outset. The next step is to ask, “How else can we support you?” This approach will hopefully set the groundwork for the employee to feel more confident to ask for help that suits their circumstances and needs. It’s also important there’s an ongoing dialogue. Needs will likely change over time and there is no set timetable for pursuing fertility investigations or treatment, or dealing with the wider health and wellbeing impacts of such a far-reaching life event.
Ideally, your wider people management and health-related policies and practices should contribute to a compassionate, inclusive and flexible workplace ethos. This is particularly important when drafting and communicating policies on sensitive issues like fertility challenges, which can be emotionally distressing. With this in mind, consider the following about your policies and practices:
- Are they written in a way that can be understood by everyone, using plain English and a tone and language that’s compassionate and demonstrates care? All too often policies use formal, legalistic language that employees don’t understand or makes them feel like a number in a system rather than a person the organisation values and wants to support.
- Are they fully inclusive? In the case of fertility challenges, investigations and treatment, is it clear that the policy covers every type of situation and is inclusive, including same-sex relationships and employees pursuing parenthood as a single person. Policies should be inclusive of partners, who should be able to access an equal level of support.
- Do they make clear that time off and/or work adjustments are available and how to access this provision? Ensure there’s clarity on the type of leave on offer and that it’s okay to take it. It’s good practice for organisations to provide work adjustments to support any individual who needs them.
- Are they flexible? Adopting a flexible and responsive approach to supporting health and managing absence should be a core element of an effective framework. For example, the use of trigger systems and disciplinary processes around absence can place additional pressures on employees. Organisations should avoid having a rigid approach to absence management and treat absences related to challenges, investigations and treatment outside any trigger system to ensure employees aren’t unfairly penalised for taking any genuine sickness absence.
- Do they allow for an individualised approach to be effectively implemented? For example, are managers capable and confident to make decisions and take action where it is in the best interests of the employee, the team and the organisation, without seeking additional sign-off from senior management or HR?
- Are they consistent across the organisation? People management practices should reflect an individualised approach to supporting health and wellbeing. But to promote fairness it’s important that there is consistency in how these are implemented by managers on a day-to-day basis across the organisation.
- Do they tell people what needs to be done and how to do it? Many policies will outline what needs to be done in practice, but few provide information about how this can be done to achieve the best outcome. For example, guidance on when, where, how to prepare and what to ask would help managers and employees hold better return-to-work conversations.
- Do they equip managers with the knowledge, skills, abilities and confidence to support employees? Line managers have day-to-day responsibility for managing people and supporting their wellbeing, and so they will often be the first port of call for employees who have experienced fertility challenges, investigations or treatment. They need to have the capability and confidence to implement the organisation’s policies, hold sensitive discussions and signpost to expert sources of help where needed, knowing the boundaries to their role.
Updating your organisation’s policies and practices to incorporate these considerations will hopefully give employees who have experienced fertility challenges, investigations or treatment the support they need and demonstrate that they are valued, benefitting both the individual and the organisation.
“It’s one of the most challenging times and often you have to return to work after invasive procedures or take annual leave to avoid questions and having to make something up, which just adds to the stress. I was made redundant in the pandemic and only then did I have a successful pregnancy – which I don’t think is a coincidence.”
Respondent to CIPD employee survey
Manage absence and leave with compassion and flexibility
Experiencing fertility issues can require employees to take multiple absences from work, particularly given the medical aspects of some treatment and/or investigations. Some absences related to fertility investigations or treatment can be hard to plan, as an individual could be called to a clinic at very short notice. Others may travel abroad for treatment and could need a certain amount of time off work.
Sometimes appointments can be fitted in around work, particularly where flexible working arrangements are in place, but this will not always be the case. Managing appointments alongside paid work can add to an employee’s stress, particularly as appointments may need to be arranged with little notice and they often don’t know how long investigations and treatment will take.
A sensitive and compassionate approach to absence management is needed to:
- create an environment where people feel able to tell their employer if they want to
- reduce any additional burden on the employee
- facilitate planning to cover absence where possible
- promote good wellbeing, performance and retention.
Organisations should ensure that their leave arrangements, as well as their absence management and return-to-work framework, reflect a flexible and compassionate approach. Information about fertility issues, and the support available for people, should be incorporated into the organisation’s health and sickness-absence-related policies and procedures.
It’s very likely that many employees who undergo treatment and/or investigations will need to take time off, for example to recover from any procedures and/or drug regimens. Employers should develop an absence management framework and supportive culture that encourages genuine reporting of the reasons for sickness absence, so employees feel able to disclose why they need to take time off. The onus is on the employer to take practical steps to create a genuine reporting climate so appropriate support can be put in place.
Absence management training and guidance for line managers should include awareness about fertility challenges, investigations and treatment. They should be flexible and take into account the potentially far-reaching impacts for both partners.
It is important to make clear that the use of any fertility leave or fertility-related absence will be treated as fully confidential.
If an employee needs to take time off work for a medical appointment related to fertility, this should be treated in the same way as time off for any other medical appointment.
Organisations need to think carefully about the amount of discretionary leave they can provide to support employees undergoing fertility investigations or treatment. This provision can include paid compassionate or special leave as well as time off for medical appointments, ensuring this provision aligns with the organisation’s other leave provision, such as bereavement leave.
To aid clarity, it could be helpful to term this leave entitlement as ‘time off for fertility investigations or treatment’ in the organisation’s policy, if it has one, and communicate it as such across the workforce. It’s also important for the policy to be flexible, reflecting the fact that people’s needs will vary. People should be able to take the leave when they need it, rather than in a block of one or two weeks, for example.
The CIPD’s own fertility journey policy aims to support its people during what can be a really difficult time, not only emotionally but also physically and often financially too. It offers up to 10 days’ paid time off (per treatment cycle) for employees who are having fertility investigations or treatment. This policy also applies if it is the employee’s partner who is undergoing fertility treatment.
The policy also recognises that “any treatment, investigations and/or counselling may leave someone feeling drained or fatigued or upset, sometimes unexpectedly”. Therefore, if an employee doesn’t feel ready to return to work straight after an appointment, for example, or “wherever you find yourself”, they are urged to speak to their manager or HR business partner if they need time away from work, even at short notice.
This flexibility reflects the compassionate approach needed to effectively support people’s unique needs in relation to their fertility journey.
The CIPD’s fertility journey policy for employees is available below.
Experiencing an unsuccessful course of fertility treatment, or ongoing fertility challenges, or having to end a fertility journey without a successful pregnancy, can be very challenging for someone’s mental and emotional wellbeing. To many people it will be experienced as a bereavement. Being offered time away from work to recover and to deal with the wellbeing impacts of their situation can help individuals to cope and hopefully remain in work.
There are various options for organisations to consider, such as:
- Paid or unpaid time off for fertility investigations and treatment: it is important to specify how much leave can be taken and when, and over what time period. Some organisations offer unlimited leave, while others give a set amount of leave that can be taken per treatment cycle or year. It is helpful if leave offered can be taken in hours rather than days, as this can be more flexible for both the individual and organisation. Our survey results show that paid time off for treatment is the most helpful form of support an employer can provide.
- Flexible hours or remote-working options, including temporary adjustments: flexible working practices can help employees adapt to treatment, attend appointments and manage emotions with less impact on their work.
- Temporary adjustments to working hours, for example reduced hours if undergoing investigations or treatment.
- Compassionate or bereavement leave for people where needed, for example where treatment is unsuccessful or ends in miscarriage.
Organisations should also consider extending their policy on leave entitlement to partners. It’s good practice to be proactive and, for example, make it clear that partners are able to attend medical appointments with their partner to empower them to actually ask for/use the entitlement. To promote an inclusive approach, a policy should make clear that it applies to any employee experiencing difficulties conceiving, or undergoing any investigations or type of treatment for fertility, or supporting a partner who is undergoing investigations or treatment.
Access the CIPD’s resources on flexible working and guidance for supporting employees experiencing pregnancy or baby loss.
If someone is off sick due to fertility challenges, investigations or treatment, their manager should have a sensitive conversation with them about how best to keep in touch during their absence. It’s also important to discuss whether or not the reason for absence will be shared with the team, which is the individual’s decision.
Any keeping-in-touch conversations should be approached with empathy and without the employee feeling any pressure to return to work before they are ready. This could include indirect pressure, for example if no cover for tasks or workload is allocated.
The line manager should plan and carry out a return-to-work interview to help ease the employee back into work when ready. An effective return-to-work interview can build trust and engagement, and support a smooth and sustainable return to work. This should be planned before the employee returns so that they know what to expect and have the opportunity to think about any issues they would like to raise, such as potential adjustments.
Managers should make it clear that this is a supportive process to help the employee make a successful and lasting return to work, as well as address any ongoing health and wellbeing needs. It’s important to remember that an employee returning could feel overwhelmed and self-conscious, particularly if they have been absent for a while. A key aim is to manage the employee’s expectations about what is expected of them and help alleviate potential stress and anxiety. Many people would benefit from being eased back into work, for example by having a phased return or working from home, as well as possible adjustments to their workload and/or duties. It’s also important to continue to check in with the employee regularly following their return as their needs may change.
The CIPD guide on managing a return to work after long-term absence sets out some guiding principles to follow when navigating the key steps to managing an effective return to work.
It’s good practice to consider making adjustments for anyone experiencing difficulties at work. Effective adjustments can be simple, low-cost and make a significant difference to how well someone can function at work. Organisations should develop clear guidance on making adjustments and incorporate specific examples of the kind of adjustments that could be helpful, such as workload or task adjustments, flexible working, temporarily reducing working hours or working from home.
Adjustments should be considered in relation to a specific individual and their specific role. The aim is to understand the barriers the employee is experiencing and put adjustments in place to resolve them. It’s very important, therefore, that a manager involves the employee in discussions about adjustments that could help. Each employee’s experience will be different, and so there is no uniform set of adjustments that an organisation can put in place.
It’s also important to highlight the ‘softer’ range of adjustments that could make a difference, such as allowing for more frequent breaks or access to a quiet space. For example, individuals could need to make or receive phone calls about highly sensitive issues such as medical results. They need to have easy access to a private room and know that they can have a conversation without being interrupted. This means managers having compassion and understanding, and not questioning why someone needs to take unplanned time away from their work.
Any guidance on adjustments should be promoted across the workforce but particularly targeted at line managers, who will typically have responsibility for having sensitive, supportive and informed conversations with employees about adjustments. The guidance should encourage managers to consider ways they can be flexible about how a job is done, and discuss options with the employee. The individual is likely to have the best ideas on what changes can make the biggest difference to how well they can do their job in the context of their health and wellbeing needs.
Typically, most organisations access OH support in a reactive way, when a particular sickness absence case is complex and/or becomes long term, for example. However, an OH service can provide a lot of proactive support, aiming to create a supportive environment to promote good health and wellbeing.
An employee who is experiencing fertility challenges can also experience wider wellbeing impacts, including mental health conditions. It’s important that managers have access to expert OH advice where possible to help them understand the potential impacts and people’s fitness to work. The specialist advice that OH can provide will be invaluable in helping managers to make tailored adjustments and support someone on an ongoing basis.
The CIPD’s factsheet on occupational health is a useful resource.
The organisation should actively promote the support it can provide to employees, and also encourage managers to access expert advice via the EAP on how the workplace can provide compassionate and relevant support for people going through this experience.
Even if an organisation doesn’t have access to OH services and/or an EAP, every employer can signpost employees to external sources of specialist support, such as Fertility Network UK and Fertility Matters at Work. See Useful resources for other helpful links such as the British Infertility Counselling Association.
“My manager was supportive and liaised with HR in confidence to have their support in taking time off.”
Respondent to CIPD employee survey
Promote good people management
Much of the day-to-day responsibility for supporting people’s health and wellbeing at work falls on line managers. They are responsible for implementing the policies and workplace adjustments that can help people to balance work responsibilities with challenging personal and wellbeing issues. A line manager will typically be the first point of contact if someone needs to discuss their health concerns and/or access support. It’s therefore essential that managers are knowledgeable about the organisation’s framework for supporting people who are experiencing fertility challenges, investigations or treatment.
However, the role of managers is to offer support and not solutions. Line managers shouldn’t be expected to be experts on the issue, or act as counsellors. Their role is to help employees with the work aspects and ensure that work is not part of the problem. Therefore, organisations should ensure that managers understand the boundaries of their role, as well as when and how to make helpful adjustments and signpost people to specialist support where needed.
Training and development interventions aimed at managers, such as EDI training and management development programmes, should include information and advice about managing in a way that supports employee health and wellbeing. This can help managers to support employees and signpost to expert sources of help. Specific guidance should include a broad understanding of fertility challenges, investigations and treatment, and how such an experience can potentially affect people, including their interaction with work.
HR professionals should ensure that managers:
- feel comfortable and competent to have empathetic conversations about sensitive and personal issues like fertility challenges, investigations and treatment
- understand how to maintain clear boundaries – they need to be clear on what their role is and isn’t
- have ready access to appropriate support for their own health and wellbeing needs, and know where to turn if they feel unable to effectively support a team member
- can access training at the point of need so that when they need to support someone, they are able to access the specific information and guidance at that point in time (instead of trying to recall a one-off training event they attended a year ago)
- be knowledgeable about how the absence management framework and leave provision can support someone in these circumstances
- understand what kind of work adjustments may be helpful
- are confident to signpost to expert sources of support such as OH, EAP, external support charities or GP services.
Flexible working hours or practices could make a significant difference to someone who is experiencing fertility challenges, investigations or treatment. Examples include reduced hours, taking extra breaks during the working day, and working from home where possible. Other ways that working life can be made more flexible for someone include:
- reducing workload
- ensuring they are not working excessively long hours
- allowing them to switch to different tasks on bad days
- permission to excuse themselves from triggering situations
- enabling them to work flexible hours and/or at home, especially on bad days or if sleep is poor.
Because every fertility journey is unique, it’s important that HR professionals and managers are able to discuss flexible working solutions on a case-by-case basis, tailored to the needs of the individual. Organisations need to be more creative and proactive in thinking about the kind of flexibility that can support people with different wellbeing needs, and educate and empower managers so that they are confident about discussing a range of flexible options and managing different working arrangements.
The CIPD’s resources on flexible working are a good source of information.
Addressing the stigma and silence about fertility issues means fostering an inclusive and supportive culture, but policies and practices such as talent management and performance management also have an important role to play.
There should never be assumptions about someone’s ability to perform to a high standard, nor should there be an assumption that someone may not want to progress their career and/or aim for promotion because they have fertility challenges.
However, it should be recognised that employees who are dealing with fertility challenges, investigations or treatment can experience a range of ongoing health and wellbeing issues. Employers need to appreciate that performance can understandably be impacted, although assumptions shouldn’t be made.
It’s important to remember that performance management should, in essence, be a positive process and focus on the support needed to help everyone perform to the best of their ability, including taking on board any underlying health and wellbeing issues. The design and implementation of an organisation’s performance management system should be based on this premise.
The CIPD’s resources on managing performance provide more information.
An organisation’s framework for supporting employees with fertility challenges, investigations or treatment should recognise that line managers themselves may need some support. It’s worth considering what specific resources are available to managers and what they can do to look after their own wellbeing. Managers should have access to EAP/OH services if organisations have them, and if not, you should point them to external helplines.
Furthermore, a line manager may not feel equipped to support someone who is experiencing this kind of situation. The employee may also want to have a conversation or seek support from someone in addition or as an alternative to their line manager. The organisation’s policy and/or guidance should offer other named contacts in the organisation, such as HR, who the employee can approach.
This guide is written by Annette Sinclair, Research Consultant, with input from Rachel Suff and Dr Jill Miller (PhD), Senior Policy Advisers, CIPD. The legal section was written by Helen Burgess, employment partner at Gateley Legal.
- Dr Krystal Wilkinson MCIPD, FHEA, Reader (Associate Professor) in HRM, Manchester Metropolitan University
- Roseanna Cawthorne, Imperial College London
- Claire Ingle and Becky Kearns, co-founders of Fertility Matters at Work
- Anya Sizer, Fertility in the Workplace Lead, Fertility Network UK
CIPD fertility journey policyA downloadable copy of the CIPD’s own fertility journey policy.
Policy checklist for assisted reproductive policies in the workplaceResearch by Cawthorne and Hardy (2023) investigated what key policy items should be included in workplace policies regarding assisted reproductive technologies and treatments
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